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Tang Li
Cardiology
About me
Beijing Boai Hospital, Cardiovascular Department, attending physician, has been engaged in clinical work in cardiac internal medicine for many years, with rich clinical experience in the diagnosis and treatment of cardiovascular diseases.
Proficient in diseases
Specializes in the diagnosis of common cardiovascular diseases such as coronary heart disease, hypertension, arrhythmia, atrial fibrillation, paroxysmal supraventricular tachycardia, heart failure, myocarditis, congenital heart disease, cardiomyopathy, and atrial septal defect.
Voices
What are the symptoms of coronary heart disease?
Some coronary heart disease patients have asymptomatic myocardial ischemia, and many may not exhibit clear symptoms of angina. Some patients can show signs of angina, with typical symptoms being a pressing pain in the anterior chest area or feelings of suffocation and shortness of breath, primarily located behind the sternum, or radiating to the precordial area and left upper limb, as well as the left side of the back. These symptoms often occur under common triggers such as physical exertion, emotional stress, overeating, or exposure to cold. If it is angina, it generally lasts less than 30 minutes and can be alleviated by rest or taking sublingual nitroglycerin. Some patients who experience a heart attack may have pain in the same areas, but the nature and duration of the pain will be significantly increased, and nitroglycerin may be less effective.
Coronary heart disease is what?
Coronary heart disease is the most common type of vascular disease caused by atherosclerosis and is a common disease that harms human health, often occurring in men over the age of forty. Men tend to develop the disease earlier than women. It is defined as atherosclerosis of the coronary arteries, causing narrowing or occlusion of the lumen, leading to myocardial ischemia, hypoxia, or necrosis, and resulting in heart disease. Currently, the diagnostic gold standard for coronary heart disease is coronary angiography. During coronary angiography, the presence of significant stenosis in the coronary artery lumen of more than fifty percent can diagnose coronary artery atherosclerotic heart disease, or coronary heart disease. The pathological anatomy and pathophysiology of coronary heart disease vary, leading to different clinical manifestations. In 1979, the World Health Organization classified it into five types: 1. Asymptomatic myocardial ischemia. 2. Angina pectoris. 3. Myocardial infarction. 4. Ischemic cardiomyopathy. 5. Sudden death. Currently, based on different characteristics of onset and principles of treatment, it is divided into two main categories: First category: Chronic coronary artery disease. Second category: Acute coronary syndrome. Acute coronary syndrome includes unstable angina, non-ST segment elevation myocardial infarction, ST-segment elevation myocardial infarction, and sudden death is also included as a manifestation of acute coronary heart disease.
What are the clinical considerations for acute pericarditis?
The treatment and prognosis of acute pericarditis depend on the cause, as well as early diagnosis and correct treatment. For various types of pericarditis, such as those presenting with tamponade syndrome, pericardiocentesis should be performed to relieve symptoms. Tuberculous pericarditis, if not actively treated, can evolve into chronic constrictive pericarditis. Patients with acute nonspecific pericarditis and post-cardiac injury syndrome may experience recurrent pericarditis after their initial episode, which is the most challenging complication of acute pericarditis. Clinically, it presents similarly to acute pericarditis, with recurrent episodes months to years after the initial onset, accompanied by severe chest pain. Most patients can be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering to normal over several months. If ineffective, corticosteroid therapy may be administered. (Medications should be used under the guidance of a doctor according to specific circumstances.)
What medicine is used for atrial fibrillation?
The current medications for atrial fibrillation mainly include three types: the first type controls the ventricular rate, which ensures the basic function of the patient's heart and minimizes the cardiac dysfunction caused by atrial fibrillation. This includes drugs such as receptor blockers and calcium channel antagonists, digoxin, amiodarone, and others. The second type of drugs are those used for cardioversion. The third type of drugs are those used to prevent embolism, which are anticoagulants. Currently, the main drugs include warfarin, new anticoagulants such as dabigatran and rivaroxaban, and intravenous medications like low molecular weight heparin calcium and nadroparin.
How to diagnose pulmonary arterial hypertension?
To accurately diagnose pulmonary hypertension, the following aspects should be considered: symptoms, signs, laboratory, and other tests. Early-stage pulmonary hypertension usually doesn't exhibit clear symptoms, but discomfort occurs during intense activities. Common symptoms include difficulty breathing, chest pain, dizziness or fainting, and coughing up blood. Additionally, patients should undergo laboratory tests such as blood tests including liver function tests and HIV antibody testing, serological tests; an electrocardiogram to check for right ventricular enlargement or hypertrophy; chest X-ray; echocardiography and Doppler ultrasound; pulmonary function tests; blood gas analysis; radioactive isotope lung ventilation/perfusion scan; right heart catheterization; and lung biopsy.
Pulmonary arterial hypertension standards
Pulmonary hypertension is a common clinical condition with very complex causes, which can be induced by a variety of heart, lung, and pulmonary vascular diseases. When pulmonary hypertension occurs, because the resistance in the pulmonary circulation increases, the burden on the right heart increases, eventually leading to right heart failure, thus causing a series of clinical manifestations. During the disease course, pulmonary hypertension commonly shows progressive development. Currently, the diagnostic criteria for pulmonary hypertension are an average pulmonary artery pressure greater than 25 mmHg measured by right heart catheterization at sea level in a resting state, or greater than 30 mmHg during exercise. Additionally, diagnosing arteriogenic pulmonary hypertension requires, beyond the aforementioned criteria, that the pulmonary capillary wedge pressure or left ventricular end-diastolic pressure be less than 15 mmHg. The severity of pulmonary hypertension can be classified into mild, moderate, and severe stages based on resting mean pulmonary artery pressure levels. Mild is defined as 26 to 35 mmHg, moderate as 36 to 45 mmHg, and severe as greater than 45 mmHg. Echocardiography is the most important non-invasive examination method for assessing pulmonary hypertension, and it is recommended that a pulmonary artery systolic pressure greater than 40 mmHg be considered indicative of pulmonary hypertension according to echocardiographic standards.
What is the prognosis of hypertrophic cardiomyopathy?
The prognosis of hypertrophic cardiomyopathy varies greatly, and it is the primary cause of sudden death in adolescents and athletes because it can progress to end-stage heart failure. Additionally, a small percentage may experience heart failure, atrial fibrillation, and embolism, but many patients have mild symptoms and can have a life expectancy close to normal. For the treatment of hypertrophic cardiomyopathy, adequate sudden death risk assessment and ICD prevention should be conducted. Because hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in young people and athletes, an ICD can effectively prevent the occurrence of sudden death. Preventing high-risk factors, including previous cardiac arrest, one or more sudden deaths in first-degree relatives, severe left ventricular hypertrophy, and findings of repetitive non-sustained ventricular tachycardia on a 24-hour Holter monitor, low blood pressure during exercise, and unexplained syncope, especially during exercise, poses a high risk of sudden death in these patients.
What are the types of pericarditis?
Pericarditis includes primary infectious pericarditis, as well as non-infectious pericarditis caused by related diseases, such as tumors, metabolic diseases, autoimmune diseases, and uremia. Based on the progression of the condition, pericarditis can also be divided into acute pericarditis, with or without pericardial effusion, chronic pericarditis, adhesive pericarditis, subacute exudative constrictive pericarditis, and chronic constrictive pericarditis. Clinically, acute pericarditis and chronic constrictive pericarditis are the most common.
Is atrial septal defect common?
Atrial septal defect accounts for about 20%-30% of all congenital heart diseases and is more common in females. Many cases are mild in children and are not discovered until adulthood. Atrial septal defects can be classified based on anatomical abnormalities into patent foramen ovale, primary atrial septal defect, and secondary atrial septal defect. A patent foramen ovale generally does not cause shunting between the two atria. A primary atrial septal defect is located at the lower part of the atrial septum, is semicircular in shape, and is often larger, frequently associated with malformation of the mitral or tricuspid valves resulting in regurgitation. A secondary atrial septal defect is situated in the middle of the atrial septum at the fossa ovalis or near the superior and inferior vena cava. The symptoms of an atrial septal defect vary with the size of the defect; minor cases may be asymptomatic, while severe cases can result in heart failure.
The difference between arteriosclerosis and atherosclerosis
Arteriosclerosis is the most common and most important among a group of vascular diseases called arteriosclerosis. The common characteristics of various arteriosclerosis include thickening, hardening, loss of elasticity, and narrowing of the arterial walls. The characteristic of arteriosclerosis is that the affected arterial lesions start from the intima, with various lesions coexisting, including local accumulation of papyraceous and complex carbohydrates, proliferation of fibrous tissue, and formation of plaques due to calcification, along with gradual degradation of the arterial media. Secondary lesions include intraplaque hemorrhage, plaque rupture, and local thrombosis formation. Modern cellular and molecular biology techniques show that arteriosclerotic lesions are characterized by migration of macrophages, proliferation of smooth muscle cells, and abundant formation of fibrous, collagen, elastic fibers, and proteoglycans as connective tissue matrices, as well as intra- and extracellular lipid accumulation. Because the lipid accumulation in the intima appears yellow and mushy, it is called arteriosclerosis. Although arteriosclerosis is only one type of arteriosclerosis, it is commonly referred to simply as arteriosclerosis due to its frequent occurrence and significant clinical relevance.